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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br />DATE/TINE <br />TYPE <br />OCCUPANCY <br />PACE <br /> <br /> 285 Church StmetNE · Room 132. Salem, Oregon97301-3670 <br /> Office Hours:8:00-4:30 · Phone:(503)588-5147o 2~HRInspect~n Une:(503)373~427 <br /> <br /> ON-SITE APPLICATIOH <br />: ~2/1~/~7 15:34 ACTIVITY NO : ?~-88881 <br />: SP STATUS : CANCEL <br />: R-3 SE APPLIED : <br />: 1 SP APPLIED : 11/BB/1976 <br /> TO EXPIRE : B2/1B/1997 <br /> <br />WORK DESC : ESE FOR LOT LINE ADJUSTMENT <br /> <br />EXIST BEDROOMS: 2 PROPOSED BEDROOMS : <br />EXIST EMPLOYEE: PROPOSED EMPLOYEES: <br /> <br />SITE ADDRESS <br /> 1205S NEAL ST SE AN <br /> <br />CITY: MARION COUNTY <br /> <br />SOBDIVISION : <br /> <br />CROSS STREET : SYAYTON RD <br /> <br />PARCEL NUMBER : 7S500-100 <br /> PARCEL SIZE : .OAC <br /> <br />LOT: 5 BLOCK: <br /> <br />OWNER <br /> ADDRESS <br /> <br />PHONE <br /> <br /> HOLLIN(,SWORTH~AL]A & ROBER[ <br /> 4684 BUENA VISTA RD S <br /> JEFFERSON <br />OR 9735~ <br />S27-192~ <br /> <br />AUTH AGENT <br />ADDRESS <br /> <br /> F'HONE : <br />~)EQ IN,qTAi, LER : <br /> <br /> PHONE <br /> <br /> Units <br /> <br /> 1 <br /> <br />HOLLINGSWORTH~ALTA & ROBERT <br />4684 BOENA VISTA RD S <br />JEFFERSON <br />OR 97352 <br />~27-1923 <br /> <br />DEQ LICENSE: <br /> <br /> Desf riptJo' Fee <br /> ' t~i :]~i n--~g .-~., ~s-~W ~--q~ ~]iTu-~ l'-6-fi---~-~ .................................. <br /> <br /> O <br /> Assessed fees 73.4~ <br /> Ad justMents , <br /> Total fees 7~.48 <br /> PAYS!E: HOLLINboWOR]FI~ALTA & RSBERT Tota! pay~tents: 7~.48 <br /> Balance due : <br /> ********************************************************************************** <br /> <br /> THIS IS HOT A PER~IT. TNIS APPLICATIOH HUST ~ THROUGH A REVIEW PRO~ESS WHERE <br /> SOIL, FEASABILITY AHD IHSTALLATIOH REOUIREMEHTS ~E CHECKED PRIOR TO THE IS~UAHCE <br /> OF A PER~IT. IT IS THE RES~HSIBILITY OF THE APPLICAHT TO A~SURE THAT ALL <br /> HECESSARY I~OR~ATIOH IS PROVIDED. AS SOON AS ALL REOUIREMEHTS OF THE REVIEW <br /> HA~E BEEH ~ET, YOU WILL BE HOTIFIE~. <br /> <br /> SIGNATURE OF APPL.!CANT: <br /> ****~******~*******~*~**~[[~[~[~[~[~[~[[[[~[[~[~[[[**~****************** <br /> <br /> DONALD E. W~ ODI.~.Y~ MARION COI~NTY BU]'.LDINf~ OFFIC!~AL / BY LIDAVIS <br /> <br />................ FOR OFFICE USE ONLY. THIS I~ NOT A PERHIT ........... <br /> HAP: ZONE: AR PROPERTY LDCATOR: 891WIgBB8S188~ <br /> SEPTIC REVIEW: DATE: ZONI~ R~IEW: DATE: <br /> <br /> <br />